肺泡蛋白沉积症的CT诊断.docxVIP

肺泡蛋白沉积症的CT诊断 袁峰1何波1祝艳翠2 (1昆明医科大学第一附属医院医学影像中心 云南昆明650032) (2昆明医科大学第一附属医院ICU云南昆明650032) 【中图分类号】R445.2【文献标识码】A【文章编号】1672-5085 (2012) 50-0243-02 【摘要】 目的 探讨肺泡蛋白沉积症的CT表现特点，提高对木病的诊断率。 方法回顾性分析7例经CT检查并经病理证实的肺泡蛋白沉积症，其中男性5 例，女性2例，平均年龄41岁。结果7例均表现为两肺对称或不对称分布弥漫 性斑片影和实变影，呈地图样改变。其中6例肺野呈磨玻璃样改变，6例呈铺路 石样改变,4例可见支气管充气征。结论PAP是一种罕见的弥漫性肺实质病变， 但其CT表现有一定特征性，再结合临床综合分析就可作出可靠的诊断。 【关键词】肺泡蛋白沉积症体层摄影术X线计算机诊断 CT diag nosis of pulm on ary alveolar proteinosis YUAN Fen gl; HE Bol; ZHU Yan? cui2 (1. Imaging Center, the 1st Affiliated Hospital of Kunming Medical University; Kunming 650032; 2. Dept, of Intensive Care Unit; 1st Affiliated Hospital of Kunming Medical University; Kunming 650032; China) 【Abstract 】 Objective: To an alyze the CT features of the pulm on ary alveolar protei nosis (PAP), in order to improve the accuracy of diag no sis. Methods: CT findings of PAP in 7 cases con firmed by pathology were retrospectively an alyzed. 5 were male and 2 were female, and the average age is 41 years old. Results: Symmetry or dissymmetry diffused patchy cloudy shadows and air-space opacities on two lungs, which were distributed geographically on Cl； were all observed in 7 cases. Ground glass shadows in 6 cases. Crazy paving appears nee in 6 cases. Air-br on chogram sign in 4 cases. Con clusi on: PAP is a rare diffuse pulm on ary parenchymal disease. But it is the typical CT features for PAP. Referring to the clinical history and we can made a reliable diag no sis. [Key words] pulm on ary alveolar protei nosis Tomography X-ray computed Diag nosis 肺泡蛋白沉积症（pulmonary alveolar proteinosis, PAP）是一种病因不明的 肺部少见疾病，是以肺泡和细支气管腔内充满大量不定形的过碘酸雪夫（PAS） 染色阳性的非可溶性富磷脂蛋白物质沉积为病理特征的肺弥漫性疾病[1-3]o本文 通过冋顾性分析7例经过病理检查证实的PAP的CT表现以及结合有关文献，对 其CT征象进行分析，旨在探讨CT在PAP诊断中的应用价值。 1材料与方法 1.1 一般资料 7例患者中男5例，女2例，平均发病年龄41岁，病程3-18个月， 既往无基础病史。7例均有胸闷，其中3例劳动或活动后感气喘，咳嗽咳痰6例， 消瘦2例，发热2例，2例逐渐出现呼吸困难、其中一例病情较重。7例均行纤 维支气管镜肺活检，2例在CT引导下经皮肺穿刺活检。病理可见肺泡腔内大量 的蛋白样物质沉积，PAS染色为强阳性。 1.2方法 7例均行胸部CT扫描。CT扫描采用SIEMENS Emotion 16,螺旋扫描，层 厚及层距均为7.5mm,范围自胸廓入口至肺底，以肺窗及纵隔窗观察。部分层 面行高分辨率C